International Office

Application Form
Please return this form to:
International Office, Coventry University
Priory Street Coventry CV1 5FB
United Kingdom
Tel +44 24 7615 2152
Fax +44 24 7615 2175
E-mail: applications.io@coventry.ac.uk

Please read the notes at the back before completing this form. It is important that you write neatly using BLOCK
CAPITALS in black ink or typescript. Incomplete application forms submitted without ALL the supporting
documents will delay the decision process. If any documents submitted in support of your application are found to
be fraudulent, the University reserves the right to reject or withdraw the application/offer made.

1. Personal details as they appear on your passport

Title (Mr/Mrs/Miss/Ms etc) Male/Female Date of Birth** (dd/mm/yy) Age

Family Name First Name(s)
Correspondence Address* Home Address (if different)*

Postcode Postcode
Mobile (including international code) Mobile (including international code)
Telephone (including international code) Telephone (including international code)
Current E-mail
*If you only have a P.O. Box address, we cannot deliver by Courier (i.e DHL) ** Students must supply a date of birth otherwise online enrolment will not be possible

Do you have any criminal convictions? Yes No

(Your enquiry cannot be processed if you do not complete this section - see Notes for Guidance)

2. Disability/special needs

Please enter the appropriate code in the box provided if you have a physical or sensory disability which Code
might in some way affect your studies at Coventry University or may require special facilities or treatment.
(See Notes for guidance.) Please provide full details in Section 9.

3. Fee status

Country of Birth Nationality

Country of permanent residence
Date of first entry to the United Kingdom
Who is expected to pay your fees? (e.g. Government, employer, family, other - evidence must be provided)

4. Details of course(s) for which you wish to apply

Course Title Course Stage/Year Month/Year of Entry

Do you wish to do a professional placement/Sandwich course? Yes No

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 5. Academic Qualifications 8. Personal statement

Applicants should list all subjects taken, whatever the result, in date order. Please state your reasons for choosing the course, relevant experience, and career plans. Please attach on a
If you are awaiting the result of any examination or are about to take one write PENDING in the result column. seperate piece of paper.
Please attach evidence of all known results.

Level Programme of Study Date (mm/yy) Name of Institution Qualification and Result Language of Study
9. Physical or other disability or medical condition

Please state any condition which might necessitate special arrangements or facilities. Consult Notes for
Guidance under Section 2.

6. English Language Requirements

Please complete this section as it is vitally important in determining your English level and whether you meet our English entry criteria. 10. References on official headed note paper

Do you have any of the following English Language qualifications? ( Please tick where appropriate ) Name and address of at least one referee (if possible, references should be sent with this form in sealed envelopes.)
Please see guidance note 10. MBA applicants should supply evidence of any work experience.
IELTS TOEFL CAMBRIDGE WELT GCSE

Other ( please state )

Grade/Score

Date achieved
11. Declaration
7. Work experience I confirm that, to the best of my knowledge, the information given in this form is correct and complete. I have read
Please give details of work experience, training and employment. Continue on a separate sheet if necessary. the Notes for guidance, in particular those relating to this section. I understand these instructions and I agree to
abide by the conditions set out there.
Job title and nature of work/training Name of Organisation From (mm/yy) To (mm/yy) Full- or Part-time
Signature of Applicant ____________________________________ Date ____________________________________

Please note that due to the Data Protection Act 1998 we can only talk or correspond with you about your
application. If someone else calls or contacts the University on your behalf we require your written permission
before we can respond (eg Parent, relative, sponsor, etc.)

If your application for a taught course at Coventry University is unsuccessful, and you are eligible, we would like to
forward your application to our International College. If you do not want us to do so, please tick this box

www.coventry.ac.uk/international www.coventry.ac.uk/iowap May 2008 www.coventry.ac.uk/international www.coventry.ac.uk/iowap May 2008

IMPORTANT NOTE
Coventry University will take all reasonable steps to provide the educational service set out in its prospectuses.
Should industrial action or other circumstances beyond the control of Coventry University interfere with its ability to
provide such a service, Coventry University will take reasonable steps to minimise the resultant disruption. Coventry
University does not undertake any absolute obligation whatsoever to provide an educational service in the manner
specified in its prospectuses or in any other document, nor does it undertake any other obligation in respect of the
provision of an educational service which is more onerous than the obligations set out therein.

Should you become a student of Coventry University, this notice shall be a term of any contract between yourself
and the University. Any offer of a place made to you by Coventry University is made on the basis that in accepting
such an offer you signify your consent to the incorporation of this notice as a term of any such contract.

Notes for guidance

General Section 3 Fee status

Before completing the form, please ensure that you read these notes
carefully. You should also read the current Coventry University
literature relating to the course(s) in which you are interested.
Mature students
Coventry University welcomes applications from mature students,
including those who do not have conventional qualifications for
admission to higher education in the UK. Full account is taken of
relevant experience and other educational achievements.
The Data Protection Act 1998
The information which you give on your form will be used for the
following purposes:
• To determine your eligibility for entry to Coventry University.
• To enable Coventry University to compile statistical reports.
• To enable Coventry University to initiate your student record.
• To share information with other government departments
(e.g. immigration office), local authorities and other bodies to
prevent possible fraud and to enable them to carry out
their functions.
Section 1 Personal details
Complete this section in BLOCK CAPITALS.
Criminal convictions
Your application cannot be processed if you do not complete this
section. If you enter ‘yes’ in the box you may be asked to send in
further information.
Section 2 and Section 9
Disability/special needs
Please enter in the box the code from the list of statements below
which is most appropriate to you. Describe your condition in Section 9
and, where it is not obvious, indicate whether you have special needs.
Disabilities/support required:
0 You do not have a disability nor are you aware of any additional
support requirements in study or accommodation.
I You have dyslexia.
2 You have a sight impairment.
3 You have a hearing impairment.
4 You use a wheelchair or have mobility difficulties.
5 You need personal care/support.
6 You have mental health difficulties.
7 You have an unseen disability (e.g. diabetes, epilepsy, asthma).
8 You have two or more of the above special needs.
9 You have a disability not listed above.
Please state your country of permanent residence and give details of
who you expect to pay your fees for the proposed course.
Section 4 Details of course(s) for which you wish to apply
If you wish to indicate an order of preference for your course choices
you may do so. If you do not indicate an order of preference then it will
be assumed that you have none.
Section 5 Examinations
Enter the exact subject name used by the examining body and the
name of the examining body in full. If you have qualifications obtained
outside the UK, you should give details of all examinations taken as
preparation for entry to higher education (e.g. School and Higher
School Certificate, Apolytirion, Baccalaureat). Applicants with
qualifications obtained in a language other than English, must attach
a certified English transcript to the form.
Section 6 English Language Requirements
Please complete this section as it is vitally important in determining
your English level and whether you meet our English entry critieria.
You should include a copy of any English qualifications.
Section 7 Work experience
Please include all your work experience and training, paid or unpaid,
full or part-time. This information will be used by admissions staff in
assessing the information provided in Section 8.
Section 8 Personal statement
Enter here any information you may wish to offer in support of your
application. Admissions Tutors will be interested in your reasons
for choosing the course(s), your career aspirations and relevant
experience.
Section 10 References
Two academic references must be sent or one academic reference and
one work reference. Referees must comment on your likely ability to
follow and succeed on the course.
Section 11 Declaration
Any offer of a place which you may receive is made on the
understanding that in accepting it you agree to abide by the rules
and regulations of Coventry University and by signing this form you
are confirming your agreement to this. Any false information provided
or misrepresentation can mean withdrawal of any offer made. If your
application is rejected because you do not meet the University entry
requirements for the course applied for, we would like to pass your
application onto our International College for consideration. If you do
not want your application to be forwarded please opt out by ticking the
box provided.

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